subchapter 16Q - GENERAL ANESTHESIA AND SEDATION

 

section .0100 – DEFINITIONS

 

21 NCAC 16Q .0101           GENERAL ANESTHESIA AND SEDATION

DEFINITIONS

For the purpose of these Rules relative to the

administration of minimal conscious sedation, moderate conscious sedation,

moderate conscious sedation limited to oral routes or nitrous oxide inhalation,

moderate pediatric conscious sedation or general anesthesia by or under the

direction of a dentist, the following definitions shall apply:

(1)           "Analgesia" – the diminution or

elimination of pain. 

(2)           "Anti-anxiety sedative" – a

sedative agent administered in a dosage intended to reduce anxiety without

diminishing consciousness or protective reflexes.

(3)           "Anxiolysis" – pharmacological

reduction of anxiety through the administration of a single dose of a minor

psychosedative, possibly in combination with nitrous oxide, to children or

adults prior to commencement of treatment on the day of the appointment which

allows for uninterrupted interactive ability in a totally awake patient with no

compromise in the ability to maintain a patent airway continuously and without

assistance.  Nitrous oxide may be administered in addition to the minor

psychosedative without constituting multiple dosing for purpose of these Rules.

(4)           "Behavior control" – the use of

pharmacological techniques to control behavior to a level that dental treatment

can be performed effectively and efficiently.

(5)           "Behavioral management" – the use

of pharmacological or psychological techniques, singly or in combination, to

modify behavior to a level that dental treatment can be performed effectively

and efficiently.

(6)           "Competent" – displaying special

skill or knowledge derived from training and experience.

(7)           "Conscious sedation" - an induced

state of a depressed level of consciousness that retains the patient's ability

to independently and continuously maintain an airway and respond appropriately

to physical stimulation and verbal command, and that is produced by

pharmacologic or non-pharmacologic agents, or a combination thereof.  In

accordance with this particular definition, the drugs or techniques used shall

carry a margin of safety wide enough to render unintended loss of consciousness

unlikely.

(8)           "Deep sedation" – an induced

state of a depressed level of consciousness accompanied by partial loss of

protective reflexes, including the ability to continually maintain an airway

independently or respond purposefully to verbal command, and is produced by

pharmacological agents.

(9)           "Direct supervision" – the

dentist responsible for the sedation/anesthesia procedure shall be physically

present in the facility and shall be continuously aware of the patient's

physical status and well being.

(10)         "Facility" – the location where a

permit holder practices dentistry and provides anesthesia/sedation services.

(11)         "Facility inspection" - an on-site

inspection to determine if a facility where the applicant proposes to provide

anesthesia/sedation is supplied, equipped, staffed and maintained in a condition

to support provision of anesthesia/sedation services that meet the minimum

standard of care.

(12)         "General anesthesia" - the

intended controlled state of a depressed level of consciousness that is produced

by pharmacologic agents and accompanied by a partial or complete loss of

protective reflexes, including the ability to maintain an airway and respond

purposefully to physical stimulation or verbal commands.

(13)         "Immediately available" – on-site

in the facility and available for immediate use.

(14)         "Local anesthesia" – the

elimination of sensations, especially pain, in one part of the body by the

regional application or injection of a drug.

(15)         "May" – indicates freedom or

liberty to follow a reasonable alternative.

(16)         "Minimal conscious sedation" – conscious

sedation characterized by a minimally depressed level of consciousness, in

which patient retains the ability to independently and continuously maintain an

airway and respond normally to tactile stimulation and verbal command, provided

to patients 13 years or older, by oral or rectal routes of administration of a

single pharmacological agent, in one or more doses, not to exceed the

manufacturer's maximum recommended dose, at the time of treatment, possibly in

combination with nitrous oxide.  Minimal conscious sedation is provided for

behavioral management.

(17)         "Minor psychosedative/Minor

tranquilizer" – pharmacological agents which allow for uninterrupted

interactive ability in a patient with no compromise in the ability to maintain

a patent airway continuously and without assistance and carry a margin of

safety wide enough to render unintended loss of consciousness unlikely.   

(18)         "Moderate conscious sedation" –

conscious sedation characterized by a drug induced depression of consciousness,

during which patients respond purposefully to verbal commands, either alone or

accompanied by light tactile stimulation, provided to patients 13 years or

older, by oral, nasal, rectal or parenteral routes of administration of

multiple pharmacological agents, in multiple doses, within a 24 hour period,

including the time of treatment, possibly in combination with nitrous oxide. 

Moderate conscious sedation is provided for behavior control.

(19)         "Moderate conscious sedation limited to

oral routes and nitrous oxide inhalation" – conscious sedation

characterized by a drug induced depression of consciousness during which

patients respond purposefully to verbal commands, either alone or accompanied

by light tactile stimulation, provided to patients 13 years or older, by oral

routes of administration and nitrous oxide inhalation, of single or multiple

pharmacological agents, in single or multiple doses, within a 24 hour period. 

Moderate conscious sedation limited to oral routes and nitrous oxide inhalation

is provided for behavior control.

(20)         "Moderate pediatric conscious sedation"

- conscious sedation characterized by a drug induced depression of

consciousness, during which patients respond purposefully to verbal commands,

either alone or accompanied by light tactile simulation, provided to patients

under 13 years of age, by oral, nasal, rectal or parenteral routes of administration

of single or multiple pharmacological agents, in single or multiple doses,

within a 24 hour period, including the time of treatment, possibly in

combination with nitrous oxide.  Moderate pediatric conscious sedation is

provided for behavior control.

(21)         "Must" or "shall" –

indicates an imperative need or duty or both; an essential or indispensable

item; mandatory.

(22)         "Parenteral" - the administration

of pharmacological agents intravenously, intraosseously, intramuscularly,

subcutaneously, submucosally, intranasally, or transdermally. 

(23)         "Protective reflexes" – includes

the ability to swallow and cough.

(24)         "Supplemental dosing" – the oral

administration of a pharmacological agent that results in an enhanced level of

conscious sedation when added to the primary sedative agent administered for

the purpose of oral moderate conscious sedation, and which, when added to the

primary agent, does not exceed the maximum safe dose of either agent,

separately or synergistically.

(25)         "Vested adult" – a responsible

adult who is the legal parent or guardian, or designee of a legal parent or

guardian, entrusted with the care of a minor following the administration of

general anesthesia or conscious sedation.

 

History Note:        Authority G.S. 90-28; 90-30.1;

Eff. February 1, 1990;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. July 3, 2008; August 1, 2004.